College welcomes back residency graduates as fellows

Dr. Blake DeWitt

Three recent graduates of The University of Alabama Family Medicine Residency are returning to the College of Community Health Sciences as fellows. Drs. Carrie Coxwell and Blake DeWitt join the College’s Obstetrics fellowship, and Dr. Keirsten Smith joins the Sports Medicine fellowship.

The college operates the UA Family Medicine Residency, which is the third largest family medicine residency in the country and one of the oldest.

The Obstetrics and Sports Medicine fellowships, along with Behavioral Health, Emergency Medicine, Geriatric Medicine, Hospital Medicine, and Rural Public Psychiatry comprise the seven fellowships offered by the College. Each fellowship is a year-long program designed to offer additional, specialized training to physicians.

Dr. Carrie Coxwell

The College’s Obstetrics Fellowship for family medicine physicians, one of the first in the country, aims to address the need for obstetric and gynecological care in rural areas. As the attrition of obstetricians in the United States exceeds the number of obstetricians completing residencies and entering practice, programs that train family medicine physicians to provide quality obstetrical care will continue to grow in importance.

The College’s OB fellows are supervised by board-certified OB/GYNs and train for 12 months to complete the requirements for certification. During the year, fellows master high-risk, operative obstetrics and office OB/GYN procedures, including ultrasound, colposcopy, cryotherapy and endometrial biopsies. Coxwell and DeWitt also join University Medical Center, which the College operates, as members of the family medicine practice and will care for patients and teach medical students and residents.

Coxwell is a graduate of the University of Alabama School of Medicine and DeWitt is a graduate of Texas Tech University Science Center. Both Coxwell and Dewitt completed their residency training at the College.

Dr. Keirsten Smith

The College’s Sports Medicine Fellowship offers education, training and certification to family medicine physicians, who are often called to serve as team physicians for high school sports programs in their communities.

During the year-long Sports Medicine Fellowship, Smith will work under the supervision of Dr. James Robinson, who holds the College’s Endowed Chair in Sports Medicine, and will receive training in sports medicine care. Sports Medicine fellows work with The University of Alabama athletic team physicians, coaches, trainers and athletes, and with local high school athletes. Fellows see patients at the College’s Dr. Bill deShazo Sports Medicine Center, located within University Medical Center, which is operated by the College.

Smith earned her medical degree from American University of the Caribbean in Sint Maarten, Netherlands Antilles and completed her residency at the College of Community Health Sciences.

Chief residents named for 2017-18 academic year

Three resident physicians in the College’s Family Medicine Residency were selected chief residents for the 2017-2018 academic year. They are Drs. Steven Kelton, Brianna Kendrick and Natalie Kuijpers.

Residency Director Dr. Richard Friend says the three have demonstrated academic and clinical excellence as well as an ability to work well with team members. They were selected by their peers.

The College’s residency is a three-year program that provides specialized training in the discipline of family medicine. The residency is the second largest family medicine residency in the nation and one of the oldest.

Kelton received his bachelor’s degree from the University of Waterloo in Ontario, Canada. He earned a master’s degree in Adolescent Education from D’Youville College in Buffalo, New York. He earned his medical degree from the Medical University of the Americas in Nevis, West Indies.

Kendrick received her bachelor’s degree in Psychology from the University of Louisville in Kentucky. She completed medical school at the Kentucky College of Osteopathic Medicine at the University of Pikeville.

Kuijpers received her bachelor’s degree from Queen’s University in Kingston Ontario, Canada, and a degree in X-ray technology from Eastern Ontario School of X-ray Technology. She earned her medical degree from St. George’s University in Granada, West Indies.

The three will replace current chief residents Drs. Shawanda Agnew, Carrie Coxwell and Blake DeWitt.

College receives grant to provide colonoscopy training to faculty and residents

By Kimberly Florence

The College of Community Health Sciences wants to increase the number of colonoscopy procedures performed by family medicine physicians in underserved communities of rural Alabama, and it plans to accomplish this goal through a grant from the American Cancer Society.

Dr. Richard Friend, director of the College’s Family Medicine Residency, applied for the grant in early 2016. In June 2016, the College received an endowment of $70,000 that matched an additional $70,000 from CCHS.

The money will be used to fund colonoscopy training for the Family Medicine faculty and residents, said Friend.

“The purpose of this grant is to train more providers to do colonoscopies throughout the state,” he said. “The way we are approaching that is by training more faculty who will in turn train more residents.”

The grant will fund the purchase of a high-fidelity simulator that faculty and residents will use to learn. The simulator uses computerized manikins to guide providers through performing the procedure and records proficiency. Once providers have met certain requirements, they can to move on to assisted cases in surgery with live patients. Friend says the simulator will be purchased in about a month.

Residents will begin their training under the direction of Friend. Dr. Drake Lavender, associate professor of Family Medicine.

Two faculty members will also receive training: Dr. Jared Ellis, associate director of the Residency, and Dr. Ed Geno, associate professor of Family Medicine. Once they complete their training, they will join Friend and Lavender in training residents.

The majority of residencies across the country do not provide colonoscopy training and family medicine physicians perform only 8 percent of colonoscopies in the state, said Friend. By training more family physicians to perform the procedure, the College hopes to provide greater access to patients in rural areas who may not be able to get to an urban setting where the majority of colonoscopies are performed, said Friend.

“There are people in our region who can’t get to the larger metropolitan areas like Tuscaloosa and Birmingham,” Friend said. “We hope to provide these services in smaller rural medical centers where they’re needed the most.”

The College’s mission is to improve and promote the health of individuals and communities in Alabama and the region through the provision of high quality, accessible healthcare, and one of the ways it does that is by sending its trained physicians into Alabama’s rural and underserved communities.

Alumnus, antivenin developer speaks to med students about snakebites

Resident speaks about hypertension at Mini Medical School

One in three adults in America has hypertension, according to the US Centers for Disease Control and Prevention. However, hypertension can be treated with lifestyle modifications and medications, said Dr. Brittney Anderson, a third-year resident physician at The University of Alabama Family Medicine Residency.

Dr. Brittney Anderson, third-year resident at The University of Alabama Family Medicine Residency

Dr. Brittney Anderson, third-year resident at The University of Alabama Family Medicine Residency

Anderson provided a presentation on hypertension on Nov. 3 as part of the Mini Medical School program conducted by the UA College of Community Health Sciences in collaboration with UA’s OLLI program.

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and residents provide information about issues and advances in medicine and research. OLLI, short for the Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel.

Anderson started her presentation by illustrating hypertension, or high blood pressure.

“Think of it the way you would think of pressure from a water hose. What would alter that pressure? The size of the hose, and what the fluid in the hose is having to overcome,” she said.

Cholesterol buildup, for instance, can inhibit blood from moving at a normal pressure through blood vessels, she said.

Diagnosing hypertension starts with an accurate blood pressure reading, which can sometimes be challenging due to faulty or inaccurate measuring cuffs or other factors with the patient and environment, Anderson said.

She offered tips for an accurate blood pressure reading. First, be at your calmest—don’t worry about engaging in conversation. Second, support your back and feet, and keep your legs uncrossed. Third, empty your bladder so that it doesn’t affect your body’s stress level. And fourth, keep your arm supported at your heart level and make sure the cuff is over your bare arm (and not your clothes).

If patients are using an automated cuff for measuring blood pressure at home, the physician may ask that it be brought in for the exam to compare, Anderson said.

Normal blood pressure less than 120 mm Hg systolic and less than 80 mm Hg diastolic. Prehypertension is between 120-139 mm Hg systolic and 80-89 mm Hg diastolic. When the systolic reads 140-159 mm Hg, and diastolic reads 90-99 mm Hg, the patient may be diagnosed as Hypertension Stage 1. Hypertension Stage 2 is when the systolic is 160 mm Hg or higher, and the diastolic reading is 100 mm Hg or higher. A Hypertensive Crisis, which requires emergency intervention, is when the systolic is read at higher than 180 mm Hg and higher than 110 mm Hg diastolic.

If a patient has an elevated blood pressure reading of greater than or equal to 180/110 mm Hg, then the diagnosis is clearly hypertension, Anderson says.

“But if not, then we have to do some more digging,” she said. It could be that the patient suffers from “white coat hypertension,” which means the patient is nervous simply from being in the doctor’s office. Patients in that case would be asked to wear an ambulatory blood pressure cuff 24 hours a day for a few days for an accurate measurement.

Or, if a patient is diabetic, it causes damage to blood vessels. That means that if a reading is greater than 130/80 mm Hg and the patient is diabetic, then it is a diagnosis of hypertension.

There are risk factors that lead to hypertension, Anderson said. Primary risk factors include age, obesity, family history, race, diet and exercise and alcohol use. Secondary risk factors include medicines (like decongestants, birth control and steroids), illicit drugs, sleep apnea and renal disease.

Hypertension can be treated through lifestyle modifications, like weight loss, adopting an eating plan, adding physical activity and reducing alcohol and sodium intake, Anderson said. There are many medications, too. Thiazides, ACE inhibitors and calcium channel blockers are some of the most common.

Southeast Sun: New medical school program brings Birmingham native to Enterprise

Lissa Handley Tyson is a Birmingham native, but she says she has come to love the smaller city of Enterprise.

Tyson came to Enterprise to work with Dr. Beverly Jordan and others with Professional Medical Associates. She is a third-year medical student at the University of Alabama Birmingham’s Tuscaloosa campus and is one of nine medical students taking part in the Tuscaloosa Longitudinal Community Curriculum offered through the University of Alabama School of Medicine. This is the third “pilot” year of the program.

Through the Tuscaloosa Pre-K Partnership, UA students deliver academic and medical services to preschoolers and their families

The initiative offers broad health services through partnerships with UA’s School of Medicine, Family Medicine Residency, Speech and Hearing Center and Capstone College of Nursing.

New faculty join CCHS

Dr. Nathan Culmer is assistant professor and director of Academic Technologies and Faculty Development.

Culmer leads the utilization of educational and simulation technology as well as distance technology aspects of telehealth services. He also oversees faculty development and is expanding continuing medical education at the College.

Culmer received his bachelor’s degree from Utah State University, his master’s in human communication studies from California State University, Fullerton, and a doctorate in higher education at the University of Iowa. Before joining the College, he spent four years at Pennsylvania State University with responsibilities in instructional design and organizational development.

Dr. Cecil D. Robinson is associate professor and director of Learning Resources and Evaluation.

Robinson works with undergraduate and graduate medical education and educators and administrators at the University of Alabama School of Medicine to examine, assess and improve educational practices, processes and outcomes at CCHS. He also works to advance interprofessional education among health faculty and professionals at UA.

Robinson earned a bachelor’s degree in computer science from Northwestern University and a doctorate in educational psychology with a certificate in cognitive science from the University of Colorado, Boulder.

Before joining CCHS, Robinson was an associate professor of educational psychology for the Department of Educational Studies in Psychology, Research Methodology, and Counseling at UA’s College of Education. His research focuses on hope and well-being in educational and community settings.

College merges departments to create Department of Family, Internal and Rural Medicine

The College of Community Health Sciences’ departments of Family Medicine and Internal Medicine have joined, and along with the College’s Rural Health Leaders Pipeline programs, now form the Department of Family, Internal, and Rural Medicine, or FIRM. The University of Alabama Board of Trustees approved the merger at its June 2016 meeting.

Dr. Richard Streiffer, dean of the College, said the departments of Family Medicine and Internal Medicine were already collaborating in many ways, including a joint inpatient teaching service created in 2015 and through the College’s geriatrics program. Rather than continuing as two separate departments, consolidation will benefit patients, medical students and residents, says Streiffer.

“Medical practice and training are becoming much more interdisciplinary, interprofessional and collaborative than ever before,” Streiffer says. “Our structure dates back to the origins of the College, for the most part, and has perpetuated ‘silos’ that no longer make sense.”

Plus, the primary aim of the Rural Health Leaders Pipeline is to prepare students from rural areas of Alabama to provide health care in rural areas—particularly as family medicine physicians.

“Hence, the creation of FIRM into a single administrative unit gives us the unique opportunity to realign these key programs and disciplines, resources and strategies to be more collaborative and, ultimately, more effective,” Streiffer says.

Dr. Richard Friend, director of the College’s Family Medicine Residency and chair of FIRM, says the merger will also allow the College to reexamine its use of clinical space in University Medical Center for efficiency.

Being part of a single unit, FIRM will be able to more easily implement clinical guidelines and processes as part of the College’s ongoing effort to become certified as a Patient-Centered Medical Home, as well as continue to increase collaboration in research and education.

Dr. Scott Arnold will serve as vice chair of FIRM and division director for internal medicine. Dr. Catherine Scarbrough, associate residency director, will provide oversight of curricular aspects of residency and fellowship education within the department. Dr. Jane Weida, associate residency director, will serve as director of all FIRM clinics. Dr. John Wheat continues as director of the Rural Health Leaders Pipeline.

College adds Emergency Medicine Fellowship

The College of Community Health Sciences is adding to its offering of graduate medical education an Emergency Medicine Fellowship.

The one-year program, which is provided in conjunction with Rush Foundation Hospital in Meridian, Mississippi, will accept two fellows who will start their rotations in July 2017.

The program will be based primarily at Rush Foundation Hospital, and will include rotations through radiology, anesthesia, orthopedics and trauma, and advanced courses in obstetrics, airway management and advanced life support.

Some of the rotations will take place at DCH Regional Medical Center in Tuscaloosa.

Funding for the program is provided by Rush Foundation Hospital, and Dr. Richard Friend, director of The University of Alabama Family Medicine Residency, which the College operates, says that more funding is being sought to grow the program over time.

Friend, who specializes in emergency medicine, says establishing this fellowship has been a goal since he arrived at the College in 2013.

“Fifty percent of all family physicians do some sort of urgent care or emergency medicine, and I think this will provide another venue for advanced education in areas where family medicine physicians might need some additional training,” he says.

Friend, along with Dr. Tamer Elsayed, assistant director of the College’s Family Medicine Residency and an alumnus of the Residency, and Dr. Walt Willis, the Emergency Room director at Rush Foundation Hospital, will work to develop the curriculum. Elsayed and Willis will direct the fellowship.

The College provides training in sub-specialties of family medicine to suit the needs of communities in Alabama and the region, including obstetrics, sports medicine, hospital medicine, behavioral health, rural public psychiatry and geriatric medicine.

For more information about the fellowships the College offers, visit fmr.ua.edu/fellowships.